Intervention may be crucial in hospital-insurer fight

The ongoing battle between Health Management Associates and Blue Cross Blue Shield of Mississippi presents a challenging situation where what should be a private business dispute is jeopardizing the access of thousands of people to health care services and therefore making the case for some sort of government intervention.

Gov. Phil Bryant, joined by Attorney General Jim Hood, have taken the first steps toward possible intervention. Bryant has informed BCBS that if a resolution isn't forthcoming, he will use executive authority to force all 10 HMA hospitals back in-network. Bryant and Hood seem to agree that BCBS poses an anti-trust threat to health care and insurance in Mississippi, thus giving the governor the ability to take unilateral action.

While BCBS is seeking a court injunction blocking any such move, the truth is that Bryant should never have been involved in the first place. He's only doing so now because of the situation in which BCBS and HMA have left the people of Mississippi.

In a nutshell, BCBS removed all 10 HMA-affiliated hospitals throughout Mississippi from their coverage network. By doing so, people with BCBS insurance now face paying higher costs for medical procedures than they would when the HMA facilities were in-network. While HMA is making up the difference between the charges for in-network and out-of-network care, they have said it is only a matter of time before they no longer can afford to do so and have to start closing hospitals.

BCBS says they made a business decision because HMA would not accept lower reimbursement rates for covered services. The insurance provider says HMA has the highest rates for medical procedures in the state, a claim largely supported by an analysis by The Clarion-Ledger of rates charged by hospitals across Mississippi.

HMA, however, says that BCBS unilaterally started paying lower reimbursement rates than they had contractually agreed to pay. After reportedly asking BCBS to make up the difference and them refusing, HMA filed a lawsuit seeking the disputed reimbursements. HMA also claims that the charges they list for services only impact Medicare reimbursements and not BCBS reimbursements, which they say are contractually fixed at a set amount.

While we would hope that these two businesses - both valuable corporate citizens of Mississippi - would find a way to come to a workable solution that would keep HMA hospitals open and in the BCBS coverage network, it looks increasingly unlikely that they will. If HMA starts shuttering hospitals, the people of Mississippi stand to lose more than HMA as a corporation.

In some communities - like Clarksdale and Booneville - an HMA hospital is not only the main provider of health care services, it is one of the largest employers and a major part of the city's tax base. The latter is true for Flowood and Brandon.

HMA, Bryant and Hood have asked Insurance Commissioner Mike Chaney to step in and require BCBS to place HMA hospitals in their network, but so far Chaney has refused. Chaney has the authority to force insurers to accept certain providers where not doing so would detrimentally limit access to health care. Chaney is not convinced this situation rises to that level of concern, but HMA, medical providers and municipal leaders in various parts of the state believe it does.

It seems almost irrefutable that the closing of HMA hospitals in rural Mississippi would cause an access issue. Based on interviews with doctors - admittedly at HMA facilities - strong arguments can be made that access issues in neonatal, pediatrics, certain surgical fields and burn treatments would exist if metro-area facilities closed.

As for BCBS, they have remained rather closed-off regarding the issue. While they have issued press releases and responded to some questions, they have not responded to multiple requests for in-depth interviews with our editorial board. Like we did with HMA, we wanted to talk with BCBS officials to better understand the issue and provide our readers - their customers - with as full and accurate an account of this situation as possible.

As it stands, we can go only off of the information they have chosen to share and the testimony they gave at a legislative hearing earlier this year.

Based on that, it seems likely that if Chaney does not intervene, we could have a health care crisis on our hands. Furthermore, several cities could face serious economic issues if these hospitals close.

We don't want to see government involved in a private business affair, but this private business affair is threatening access to health care.

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Intervention may be crucial in hospital-insurer fight

The ongoing battle between Health Management Associates and Blue Cross Blue Shield of Mississippi presents a challenging situation where what should be a private business dispute is jeopardizing the